Posted
by
ScuttleMonkey
on Saturday January 19, 2008 @12:30AM
from the what's-up-doc dept.

mytrip writes to mention that the same people who invented credit scores are working to create a similar system for hospitals and other health care providers. "The project, dubbed "MedFICO" in some early press reports, will aid hospitals in assessing a patient's ability to pay their medical bills. But privacy advocates are worried that the notorious errors that have caused frequent criticism of the credit system will also cause trouble with any attempt to create a health-related risk score. They also fear that a low score might impact the quality of the health care that patients receive."

They also fear that a low score might impact the quality of the health care that patients receive.

Of course this will impact the quality of healthcare that people receive. Don't be absurd. Look, as someone who is involved in his family business (12 docs, 100 total employees), the ability of patients to pay is fundamental because healthcare is a business. Doctors graduate medical school with six figures in debt, buildings cost money, running a business with good people takes money to pay your employees with and more. It is hard enough as a small business in medicine, but competing with larger hospital groups who make access like this part of their business practice (like HMOs) are making it even harder because they shunt patients who are less able to pay to the local doctors or smaller clinics, and these are the businesses that suffer the burden of non-payment.

What is the solution? Trying to figure out who has what insurance (some insurance is better than other types) and who can afford to pay for more expensive procedures is just bad medicine and bad social responsibility. Socialized medicine is not it either, however, a return to fee for service medicine is a better option for all people involved. Scrap the HMOs (who are in business to make money, not provide health care), scrap the insurance companies (middle men extracting their pound of flesh) and return to a system where you pay for services rendered with insurance for catastrophic coverage. Granted, many specialized procedures will not be utilized as much but health care coverage for two healthy people is often in the $8k-$12k/year range as it is. And what is the average American getting for that expenditure? You are paying typically out of pocket expenses on top of that as well if you do take advantage of health care services and if you prove a bad insurance risk, you get dropped entirely. Look, insurance companies are not in business to help you stay healthy, or get well... They are publicly traded companies who's bottom line is profit and that profit comes at your expense. A classic parasitic business model that has been promulgated on the American public. However, this will have to change as it is dragging down US business, small and large, big time.

American society is all about me. It's not about you. It's about me. Let the poor die, stupid miserable bastards. America hates the poor, grinds them up on the mill of the American Dream, grist for the wealthy. Fuck those that can't pay for health, and fuck their disgusting children. Jesus loves a rich America where the poor are crushed under the weight of big business. Money is the God of America, and Jesus is all about the Money. The only thing that counts in America is business; business and money. Society can go get fucked, because business is overlord. Congressmen sell their worthless souls to it, and those that can't afford decent health care should be given a fucking bullet and told to put it between their eyes, because America is all about me.

What we need is a way for people to reliably assess doctors and hospitals, including who charges how much, before handing their health and wallets over to them.

We also need real accountability for credit reporting agencies. Simply requiring them to change incorrect information after the damage is already for done and requiring each of us to police the companies on our own dime - is crazy. They're immune for normal charges of libel, and should not be.

Oh bullshit, socialized medicine is the solution and we've seen it work pretty well in western europe.

My ability to pay has nothing to do with my credit or money in my bank. It has everything to do if my insurance decides to screw me or screw you. An MRI I needed a couple of years ago which was supposed to be covered by insurance cost me 1500. My insurance paid them 1100. Both of those parties are just trying to screw me for cash. Instead of working with insurance companies the MRI people just pull a number out of their butts. Their inability to work with my good insurance or the insurance's inability to pay fair prices puts me in the middle of a capatalistic nightmare where my own health is used as leverage points to see who can bill the most and pay out the least. This is incredible! The most pathetic part of this was that I was told by the MRI people that if my insurance refused to pay anything they had a nice low cash price of 300 dollars. In other words theyre making money at 300, but bill 1500!

Sorry, but the only way out of this nightmare is mass socialization of medicine and getting away from the idea that my illness should make you rich.

Last time I checked, the sole reason for the existence of government is to be the servant of society. Why can't government do this? I mean, it's a government of the people, by the people and for the people, right?

I do enjoy your secret code for "Fuck the poor". Good for you. JEsus loves you.

Please spare me your petty attempt to appeal to my morality. If you want to help people, do it out of the goodness of your heart, just as Christ would want. Don't extract wealth from the population through violence (taxation).

If you want to look up my licensing status and any restrictions, as well as board certification, go right ahead - http://www.docboard.org/docfinder.html [docboard.org]. If you want to know if I'm a good match for you, you'll have to do the same thing as you would for your dentist, plumber, or lawyer - try me and see if it works out.

If you want to figure out how much I'm charging, good luck: each different plan with each distinct insurance company charges different prices for different procedures or visit types, which is often considered proprietary information so I'm not allowed to know or publicize what it is anyway, lest I collude with other physicians to get better a payment schedule.

And while some doctors may be competing for your business, as a primary care physician, I'm not - our practice (like many) limits new patients. I take Medicaid and uninsured patients along with commercial insurance, and my panel is overflowing. I'm happy to say I love my job, but the long hours, mountains of paperwork, and 13 year old car are typical of my colleagues - we're not exactly living high off the hog, or running our hands through a mountain of gold coins.

By law in the United States, no hospital with an emergency room can turn away anyone for needed care, but I can see why the folks doing elective surgeries might want to be sure you can pay your bill. This is America after all, and we are apparently a long way off from figuring out what virtually every other industrialized democracy has: private insurers are in it for the money, and are not necessarily aligned with your best interests.

Oh bullshit, socialized medicine is the solution and we've seen it work pretty well in western europe.

We already have a form of socialized medicine here in the US. I've been unemployed for several years, I'm a Type II diabetic with other, unrelated health issues, and I get all my medical care from the US government, free of charge. If I were working, I'd have to pay a co-pay, but not much. How? Oh, it was easy! All I had to do was spend three years in the US Navy, including 7 months in Tonkin Gulf back in '72.

(1) I've read several articles about socialized systems in Europe being severely in debt. If that's the case, even if its a good idea and works short term, its not sustainable. We would have to do things different that Europe, especially given the amount of debt we're in already.
(2) Purely making so much profit annoys me, but then we must remember that doctors start off with lots of debt, have to pay many bills, insurance (malpractice, etc.), not to mention the crazy expenses required to buy things like MRI machines. Do you plan on paying for your doctor to go to school? Feel like chipping in to buy an MRI? If not, then you have to pay something later on when you do need a doctor and an MRI. Oh, but the government will pay for it, right? Guess what, tax increases to offset the price (or simply more national debt). Someone has to pay for it somewhere, at least until we can reach Star Trek enlightenment and completely do away with the entire concept of money and debts (which humanity is nowhere near ready for).
Our system obviously needs improvement, but pretending that socializing medicine is going to solve all of our problems is just deluding yourself.

You are clueless. Do you really think that anyone who is against socialized medicine feels that way because they dont like poor people and they think they are better than them? The vast majority of us who want a free market for health insurance do so because we know that in the long run, everyone including the poor will be much better off. Free markets a) promote innovation and better health care and b) drive costs down. People who are against socialized medicine understand this and we have better arguments than saying that everyone who isnt on our side hates poor people.

Last time I checked, the sole reason for the existence of government is to be the servant of society. Why can't government do this? I mean, it's a government of the people, by the people and for the people, right?

Because under the Declaration of Independence, the purpose of government is the protection of the people's rights against oppression. The Preamble of the Constitution does give a longer list of purposes, but unless you accept a reading of the Constitution so broad as to render the "enumerated powers" list meaningless, ours is a government with limited powers, which means that it does not have the legal authority to do absolutely everything a majority votes for. In fact the Constitution is designed not to simply give people what they vote for. If it were, there would be no need for a Bill of Rights, because the people would simply be trusted never to, say, have 51% of the people vote to kill the other 49% and take their stuff. And if they did, a strict majoritarian belief would say that that's perfectly all right! So, before leaping to the conclusion that government ought to do something, we ought to consider whether it has any right to do so. Any coercive government action involves a reduction of the freedom which it's government's main purpose to protect, and so should be weighed carefully against this cost.

Another reason "why government can't do this" is practical. People are having the debate over just how effective foreign health systems are, usually comparing a pure socialist system to the half-socialist system we have now, but there's good reason for skepticism about whether giving our government more power over our money and other aspects of our lives is a good idea. See eg. China, Soviet Russia, North Korea, and other places where people were/are controlled allegedly for their own good.

On a related note, a government-run health system of whatever stripe leads logically to a system more intrusive than any existing today. If government is put in charge of your health, it has a legal and financial justification for controlling what you eat, where you live, how you work, what you do for fun, how you feel -- everything. Would you willingly submit not just yourself but everyone else to such a trend?

So you are saying that at the cost of the present, you're banking on tomorrow? I understand that's one argument for a free market society, but come on, you're talking about human lives. I would rather not pay for cheaper health care with the blood of my neighbours.

I suppose this is the long running socialist vs. capitalist debate, but you really need to look at the facts... socialist-democratic societies seem to be much happier, better educated, etc. then the American free market society, bent on the idea that individual happiness is best served cold with individual self-interest.

You can weight the different factors to make the countries appear in any order you want on that list. Kind of like how when USNews started ranking schools they hired guys who went to princeton to do it. Guess who consistently wins, Princeton. Same kind of thing, he who controls the weights controls the order of the list.

from putting every aspect of our lives to an index. We won't be able to get good service at a restaurant because our ACTT (Average Cost to Tip) Index is too low and the waitress is busy working the patrons with above average scores. Frugal shoppers will be stuck in long lines in the grocery store because the index that keeps track of how many high markup, name brand products we buy won't qualify us for the express lanes for prefered customers. Our MedFICO score will be shot because the new wave of Medical History Theft screwed us up before privacy and consumer laws could catch up to the problems and we'll have to goto Mexico for our routine exams.

Unfortunately the people making these indexes never have to tell single mothers with starving children that they can't use their services. They give that job to the other single mothers with starving children that they've hired minimum wage to work the reception desk. If they did, they might realize that people are actually more than the sum of their indexes.

Once again, American libertarian Slashdotters come out in droves to let us know that socialized medicine couldn't possibly work. I guess this is plausible enough, as long as you're suffering from some sort of epistemological disorder that prevents you from perceiving the universe outside the borders of the United States. Because in every other Western industrialized nation, some sort of socialized medicine has been the reality for decades, and, not coincidentally, they all provide a better standard of care to their citizens for less money than we do here in the USA. (Yes, even with the waiting lists.)

Argue, if you want, that health care shouldn't be universal on some sort of social Darwinist grounds ("The sick should die, because they are weak!"), but please stop trying to suggest that there's something inherently unworkable about government-provided health care. It's sort of like arguing that the Earth is flat or that water runs uphill: it's clearly contradicted by fact.

Anyone who understands free market capitalism should understand why it doesn't work for healthcare. The rational, informed, value-seeking man does not exist in the healthcare world. Real healthcare patients are seeking the best treatment that they can afford, not the cheapest healthcare that will probably get the job done. That's the kind of market where prices go up instead of down because the only downward price pressure is whether or not a provider can find enough people that can pay at the prices they offer.

Matters of life and death are not ruled by bargain-seeking behavior, and thus the entire driving forces of supply and demand are thrown completely out of whack. Anyone who's spent any time studying economics should recognize that the fundamental assumption of modern economic theory doesn't apply here.

In 2004, I was diagnosed with Acute Lymphatic Leukemia. At the time, I was working for a rather well known technology company that had a great benefits package, great insurance, and treated me well -- I was placed on Short Term Disability, then Long term Disability, and Aetna/BCBS paid for most of my Rx and Dr's Trips. 18 months later, in 2005, my cancer was in remission, but, my doctor didn't want me back on the road because of my immune system being in the state that it is.

I've changed employers, since then, because I grew tired of being stuck on LTD, and was 'acquired' by another company last year. Same insurance (Aetna became BCBS), similar benefits.

I go to the Pharmacy to grab my Monthly Maintenance Medication this month, only to find out that my employer removed that coverage from the benefits package. Now, I'm paying $750/month for medicine to keep me alive. No Biggie -- I go in for my monthly labwork, only to discover that my blood draws and hematologic shit isn't covered anymore. Well, now I'm kinda getting worried, because It's going to cost me another 1200 to get my lab work done. (We're at $1950/month just to keep me alive, right now, where it used to be $100 -- $80 for my meds, and $20 for the labwork).

Add on top the trips to the Dentist (I've spent over $6K with my Dentist in the past 2 years recovering from the hell that chemotherapy and Barium treatment does to your teeth), and I'm looking to probably spend $24,000 this _year_ on medical bills alone. While Flex plans help, it's really not that much.

This begs the question -- If I had chosen a different career path, and if I was working as a busboy at a restaurant, would I still be alive today?

I'm not saying that Social Medical coverage is the answer. I'm not saying that I know the answer, but, think about things like this:

My brother has a daughter that has Cystic Fibrosis. My brother barely scrapes by on minimum wage. He literally has $250K worth of medical bills from his daughter alone. He can't afford a house, I bought him the car that he drives, and every penny of his money (and every ounce of his love) goes to making sure that his daughter is alive, safe, and cared for.

Yes, I understand that Doctors work very hard to get where they are. I have two engineering degrees, and I am still paying those off at this point in time. I also understand the costs of finding and keeping good talent and staff. At what point do we say, "Your daughter can't live because you can't pay," or, "you can't live because you can't pay?"

Wow, at the rate things are going, I might have to consider doing that myself.

I am NOT joking. A hospital I went to for a gallstone is threatening to sue me for bills I cannot pay. Those guys did everything to me, gave me the premium care when I didn't ask for it. Now I'll have to either pay out the ass, or join the military.

The problem is that we have removed free markets from so much of healthcare in the name of providing access and it has crippled the ability to get affordable health care or insurance. Things like prescription drugs, imaging, etc. should not be covered. These would be affordable in a true free market society.

That's a nice fantasy.

The great 'free market' has some 12% of America living below the poverty line. 12% of America can't even afford an 'adequate standard of living' as it is. People just above the poverty line number in the millions... you really think a family of 4 making $22,000 is going to have the sort of disposable income needed for a hip replacement EVEN if medicine was a free market?

And the cost of food, fuel, heat, and rent are rising faster than wages.

Given that a (relatively) unregulated free market can't even make the BASIC NECESSECITIES of life suitably affordable to a LARGE fraction of Americans, what on earth makes you think exotic surgery, and medical procedures would be??

And even if it 'worked': Reducing a procedure thats been bloated out to $1,500,000 (due to the 'massive regulation inefficiencies' you claim) down to even $150,000 is still a death sentence to a *huge* number of people. Even $50,000 is out of reach.

Do you have proof of this? All studies I have seen on the subject are quite clear that in the US healthcare is inferior, while at the same time being the most expensive in the world.
In fact when I'm talking with someone online and they have a health issue which they don't get checked at the doctor, they are always from the US, because they don't have universal healthcare.

You want to know what the real problem is? For-profit health care serves two masters: the patent and the stockholders. Their interests are mutely exclusive. They have the obligation to provide high quality care for the patent and also the obligation to maximize profits for the stockholders. If they fail to do either they can be sued. That's not just broken, it's patently absurd.

If you ask me, profiting off human suffering is immoral and un-American.

Oh this whole subject pisses me off, but this comment just takes the cake.

I see Medicare/Medicaid and state Medicaid patients all day, every day. They pay nothing.

Not to dispute your choice of profession, but you're just plain wrong here. My husband receives Medicare, and even with that coverage, we still have to pay money out-of-pocket for every single medicine, and for every other service he needs. Case in point: my husband needs surgery to re-position and/or fuse a couple of diseased vertebrae in his lower back. The one surgeon in the area who does this kind of surgery wanted about $70,000, but Medicare only covers 80% (sometimes less) of anything you claim, leaving us to pay a $14,000 balance. That doctor also expected an additional $17,000-ish for the hospital, none of which is covered by Medicare he told us. So, my husband's total bill would have been at least $17,400 if the hospital were covered at the usual 80%, or upwards of $31,000 if the doctor is right about lack of coverage.

We are both disabled, and that second (more likely) figure is well over two years' pay for us! How the hell are we supposed to afford that kind of expense and still pay for a roof over our heads? I mean, seriously, WTF!?

As for Medicaid, whether you pay anything or not depends on the particular implementation of that program where you live. Where I live now, I haven't been able to establish what costs there might be, but where I came from in Florida, you have to pay back every penny the government spends on you should you ever come into some money down the road, no matter how much or how little. Case in point: Over the course of a couple of years, I had accrued several thousand in medical bills, all of which the government agency providing my general medical coverage paid for. I ended up being injured in a car accident (other driver rear-ended us) and received a $10,000 settlement from the offending driver's auto insurance company. Well, I got about $3000 of that settlement, my lawyer took another $2500 or something, and the government agency providing my coverage took the rest. My medical coverage was then terminated because I got too much money from the settlement. I never got back onto that program.

Translation: I paid for no less than 70% of my medical expenses, despite supposedly having health coverage. And yes, it's a Medicaid-affiliated program.

As for Social Security, Your google search has sources which claim that there were errors in the government cost estimates. What no one seems to want to tell people is that we have a surplus of funding that had been built up decades ago, and which is expected to run dry in around 2020ish. At that point, the program will still be at break-even. Take a look at The US budget for 2008 [wikipedia.org]. Expenses add up to $2.9 trillion, while the government is showing receipts of only $2.66 trillion. What the Wikipedia article doesn't say is just how much of that spending is pork and how much actually gets spent properly (I'm guessing 50:50 or worse).

By this point, I really shouldn't have to say this, but I will anyway: Stop the wars, stop the government waste, tax the rich more than you tax the poor, and put a fucking cap on the raw cost of medical care. There is NO ETHICAL REASON WHATSOEVER that (quoting a previous poster) an MRI should cost $300 for an individual but $1500 for an insurance company, that a mass-produced vial of insulin should cost $75 for one month's supply, that any pill of any kind should cost more than a few cents each, or that the aforementioned back surgery should cost anywhere close to $96,000.

And to think, this is how I felt *before* I watched "SiCKO". What scares me the most is that practically everything in that movie as far as mainstream US health care is concerned is fact. I'd be better off dead than ill in this country.

I have never understood this phrase "socialized" medicine you Americans use for a tax payer funded health care system. In the US the police forces, fire services etc are funded by tax payers but you do not describe them as "socialized" police forces etc. Public schools are funded by tax payers, do you have a "socialized" education system? Here in the UK we have had tax payer funded National Health Service for over 50 years. The NHS is just considered a public service like refuse collection, fire and police service, state education etc and from my perspective it is bizarre to talk about healthcare like it is a commodity.

"The vast majority of us who want a free market for health insurance do so because we know that in the long run, everyone including the poor will be much better off. Free markets a) promote innovation and better health care and b) drive costs down.

Do you also stand by this argument regarding fire services and police forces protecting your house and neighbourhood? Do you prefer private fire protection to publicly taxed fire departments, and private law enforcement over public police? Just curious as perplexed as it seems to me as an outsider that "socialized" fire and police protection seem acceptable but "socialized medicine" appear to be less acceptable in the USA. Wondering where the difference between these services is seen by the American public?

Every single thing you mentioned except for the highly trained labor had to do with the machine. Since, the post you responded to said "Vet labs can do MRIs for less then $200.", I fail to see why the machine cost for scanning a human would be that much higher.

As for personnel cost, sure it is expensive, but $1000 for 30 minutes? I could of course be missing something, but that is how it looks to a casual observer.

Because the insurance payouts are much higher for humans compared to animals when a technician forgets to keep a ferromagnetic object out of the room.

- All Americans have health care, even those that cannot afford it, and the idea that there are people without access to health care is a myth that inflames the clueless and serves the purposes of political propaganda. The quality is mediocre, but what do you expect with socialized medicine. It is not hypothetical, I was one of those invisible souls raised on government health care for the destitute.

There's a fairly large set of holes defined by the "underinsured" and the "uninformed".

The uninformed are those who qualify for Medicaid, but are unaware of how to apply for it, or unwilling to do so because of legal dubious status (arrest warrant, dubious immigration status, etc.). Their unwillingness may not be rational, but it's real and contributes to a LOT of people sitting around with treatable conditions, waiting until those conditions get untreatable, or just really expensive to treat.

The underinsured are those whose insurance doesn't cover what they have, or covers only a small fraction of it, or would have covered it if conditions were slightly different. They're the ones with passable or decent jobs with insurance companies that have horrible payment schedules and are slow to pay, on top of it. If their insurance is relatively new and they had ANY gap in prior coverage, there's a strong chance that it will be defined as "pre-existing condition" and they'll be completely denied.

This twist happened to a friend of mine about ten years ago; he had recently got a new job, and soon after he started was complaining of stomach pains. His employer told him that since he had been employed more than a month, his insurance had kicked in and he should get checked out. It was diagnosed as "diverticulitis", and he was given some medications and food recommendations. Fast forward two more weeks and the pain has increased and turned out to be full-blown pancreatitis. Huge chunks of his pancreas were removed, making him a diabetic. His insurance pointed back to the earlier misdiagnosis of diverticulitis, indicated that the pancreatitis was pre-existing even the start of his coverage, and denied his bill: his $120,000 bill. 25 years old, new job, 120,000 in debt. He died a year later in a diabetic coma due to poor glucose control, completely unable to pay for any medical care. He was working on bankruptcy proceedings, but this was back when it was "easier" to get a medical bankruptcy; current bankruptcy laws in the US are dramatically different - against him.

All Americans have health care, even those that cannot afford it, and the idea that there are people without access to health care is a myth that inflames the clueless and serves the purposes of political propaganda. The quality is mediocre, but what do you expect with socialized medicine. It is not hypothetical, I was one of those invisible souls raised on government health care for the destitute.

Ah, yes. As President Bush said - if you need health care, just go to the ER.

Sorry, nope. As an ER doctor, I can tell you there are many things you will never get that way. Need a pap smear? Nope, we don't do them in the ER? Need surgery and chemotherapy for your advanced cervical cancer? Again, sorry - we don't do that in the ER. Maybe when you come in bleeding out from your vagina, we'll admit you, but you won't be getting definitive care. Need surgery for your broken arm? Nope - that's not an emergency, so the only care you will get in the ER is stabilization. No orthopedist has to admit you under EMTALA to do it either, since the standard of care is splint and then follow-up for outpatient surgery. Of course when you try to make that appointment, they will tell you $20,000 up front or no follow-up appointment.

And don't play that 'I grew up on welfare' card. So did I dipshit - when it was a more decent system in the 70's and 80's. We've been going downhill since then with regard to public assistance - including health care assistance. Thank you republican controlled congress and private health insurance industry!

If in a private health-care model the insurer can decide who to insure, and cherry pick its portfolio, there's a serious possibility that some people, particularly those that are seriously ill, will be uninsurable. This is what happens in the US, where people can be turned down for "pre-existing conditions".

In such a system, health-care will be non-universal, and this misses the point of health-care, just as much as a police force or fire brigade working non-universally misses the point.

The relevant question is what governements can do and what they SHOULD do.

Something that is woefully missing from all of these rants about bringingsocialized medicine to the US is how do deal with the costs of becominga Doctor or running a hospital short of just refusing to pay the Doctors.

This is the current HMO approach and this is the current medicare approach.

All it does is make it make less sense to be a doctor.

No one seems genuinely interested in making medical care less expensiveto produce. All anyone is interested in is some sort of mass bribe tobuy votes with.

Their solution is to take a highly ineffecient and corrupt health insuranceindustry and replace it with an even more inefficient governement that iseven more prone to corruption or indifference.

Leaders should be helping to empower people rather than being enablers.

Ah okay, I misunderstood what you meant, sorry. But I don't think that equating "socialized health care" with government run medicine only really covers the debate. In that sense, the existence of public hospitals in the US makes it "partly socialized", while privately run general practitioners in Europe, make that system "partly private". Then, I think there's no controversy, and thus no issue. Health care is a mixed system in the Western world. Where the real differences are is in access to this health care, and that is where the differences are really stark. Privately controlled access (US) or publicly controlled access (the rest) are the issue, and this is what the "socialized medicine" debate is focussing on. Technically it's incorrect as you state, but this is the argument. Nobody really cares who runs the hospital, as long as they can get access to it and don't go bankrupt in the process.

There is of course an answer, and it has been implemented everywhere else in the western world but here. Remove the profit motive, eliminate the insurance companies, pay for doctors' education so they can't use it as an excuse to gouge, and regulate prices. It's a pain in the ass, but it beats what we have now, where millions die undertreated but never show up on the TV news. We've a disaster that is never reported by the millionaire talking heads on TV, because they will never see anyone dying in their life from lack of funds to pay millionaires holding the key to life.